Turnaround at UM Hospital Emergency Department Tied to Teamwork and Commitment to Change

Following a dramatic four-month rise in patient-satisfaction scores, the Emergency Department at University of Miami Hospital stands as a textbook example of what is possible when top management makes a true commitment to change and the entire staff responds to the personal satisfaction that comes from improved performance.

The satisfaction measures that UMH administrators track closely in the monthly Press Ganey Emergency Department Report are those comparing UMH with approximately 230 peer hospitals across the U.S. The response they value most is “likelihood of recommending.” In April, UMH was ranked in the bottom quarter, with a score in the 24th percentile; the current score is in the 96th percentile.

“Improvement this substantial in such a short time is a remarkable achievement,” said Pascal J. Goldschmidt, M.D., Senior Vice President for Medical Affairs and Dean of the Miller School of Medicine and CEO of UHealth. “It demonstrates what can happen when leadership and staff are given the opportunity to think of new ways to focus on the most important element in medicine — the patient. I am very proud of what they have accomplished.”

Many other measurements, ranging from arrival to release, mirrored that level of improvement. The changes behind the improved numbers, however, took much longer than four months to implement.

“I have worked here for seven years, and throughout all of that time the Emergency Department has struggled,” said Kymberlee J. Manni, Ph.D., UMH’s Chief Operating Officer. “A little more than a year ago, top management committed to a $3.9 million makeover, and for the past 12 months, my team has been on a mission to improve the department. During that time, we have re-engaged the Director, revamped the entire staff, changed our lab test procedures and completed a major renovation of the entire space.”

“The Emergency Department has been one of our areas of focus for some time,” said David Zambrana, D.N.P., M.B.A., CEO of UMH. “It is where, because of its function, we have our least-planned patient encounters. If we can provide superior care in what is often a patient’s greatest time of need, we will build a reputation that produces strong, lasting relationships with the entire community.”

“The commitment at the top empowered me to finally do what needed to be done,” said the department’s Director, Todd Haner, D.N.P., M.B.A., a highly experienced administrator who was brought to Miami in 2012 from a community hospital in Naples, Fla., to turn things around. “We really needed to shake the place up and start again. It begins with the right team; it’s easy to have people with the right skills but not the right fit. The people working here now are here for the right reasons.”

It didn’t take long, in fact, for the department’s 105 staffers to see that management’s commitment to change was real. New physicians with emergency department expertise were contracted from TeamHealth, an outsourcing organization, to work under the direction of David M. Lang, D.O., Medical Director of the department. The 32-bed facility was split into two zones, each run by a team of three nurses and two technicians. A laboratory technician was added to the department to verify orders before they are sent to the lab and track them to make sure they come back as quickly as possible.

“I am grateful to Dr. Lang for his commitment to improving the patient experience,” said Steven Falcone, M.D., M.B.A., Executive Dean for Clinical Affairs and CEO of the UHealth Clinical Practice.

The nurses’ station was torn out and rebuilt. A new clinical area with five new bays was added. Several parking spaces were eliminated, and a new reception area was built in their place. New curtains and paint lightened and brightened the whole department.

One of the biggest morale boosters was new uniforms. Staffers had a say in choosing the color of the new scrubs, which also had the hospital logo embroidered on them.

“The rest of the departments began seeing our uniforms, and they wanted embroidery, too,” said Haner. “Now there’s a spirit of competition within the hospital, and our people are proud of how good they look.”

The last frontier, he said, was the patient experience.

“We renovated not just the look but also the operation of every place that has a patient touch point,” said Haner. “For example, we added a greeter at the front desk. Instead of treating you like a number, they get up and engage you in a conversation. And we don’t call that area the ‘waiting area.’ We don’t want patients to spend much time there. We call it the ‘reception area.’”

Patients don’t leave, either, without an exit interview and a business card.

“We want their last memory to be that they were treated well,” said Haner. “If they have any issues, we try to resolve them on the spot; if that isn’t possible, we will follow up later with a phone call.”

UMH’s Emergency Department is a busy place, treating approximately 120 patients each day. As all of the changes took effect, staffers could feel the improvement and their spirits soared. Haner spurred that morale shift with a tracking board that he updates every day. The staff knows how long it takes a patient to see a physician and how long it takes a patient to be discharged, and it keeps them engaged.

“It means a lot to me when they come to me and say, ‘What’s our score today?’” said Haner. “Our people know that today’s health care consumers are savvy. How we treat them determines if they are going to come back. In today’s market, we have to go the extra mile.”